Provider Demographics
NPI:1770553737
Name:KAFA, AMMAR (MD)
Entity type:Individual
Prefix:
First Name:AMMAR
Middle Name:
Last Name:KAFA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1056
Mailing Address - Country:US
Mailing Address - Phone:315-769-4200
Mailing Address - Fax:317-769-4353
Practice Address - Street 1:181 MAPLE ST
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1012
Practice Address - Country:US
Practice Address - Phone:315-769-4704
Practice Address - Fax:315-769-4315
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270868207Q00000X
WI55607207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03806493Medicaid
NY03806493Medicaid
NYJ400138834Medicare PIN
IN200518090Medicaid
IN563420YMedicare PIN
IN563420OtherGROUP MEDICARE